Letter to Editor: Immersive Virtual Reality‐Based Rehabilitation for Upper Limb Recovery in Acute and Subacute Stroke Patients: A Feasibility Study

We read with great interest the recent article by Peralta-Wieland et al. (2026) titled “Immersive Virtual Reality-Based Rehabilitation for Upper Limb Recovery in Acute and Subacute Stroke Patients: A Feasibility Study.” This study raises an important issue in upper limb functional rehabilitation after stroke: The combination of immersive virtual reality (IVR) upper limb training and conventional rehabilitation (CR) not only shows a positive trend in improving the upper limb function of patients, but also shows a dose-response relationship, which provides a prospective basis for IVR as an innovative auxiliary rehabilitation method. Nevertheless, we believe that there are still some areas that can be improved to further improve the rigor and applicability of the study. Firstly, the dose is mainly defined by “10 times” and “20 times,” and there is a difference between the planned duration of 20–30 min and the average duration of the actual training time of 17 min, so the real dose standardization cannot be achieved. It is recommended to add objective records, such as effective repetition times, task success rate, difficulty trajectory, and rest proportion (Maier et al. 2019). Credibility will be further enhanced. Secondly, although a modular platform was used in the study to adjust the difficulty of the task, there were significant differences in the recovery of each patient, including different degrees of injury, brain region damage, and complications. Individual differences may influence the effect of IVR intervention, but these factors were not explored in depth in this study. Future research should pay more attention to the reaction of different parts or different degree damage differences, and adjust the treatment according to the individual situation. More detailed clinical and neuroimaging assessments can be performed for group patients by site of brain injury or level of neurological function and thus optimize treatment planning. Thirdly, although the recovery of upper limb function was the primary objective of this study, stroke patients often have concomitant cognitive impairment, which may affect their rehabilitation outcomes (Barbay et al. 2018). However, changes in cognitive function were not assessed. Therefore, future studies are recommended to include cognitive function in the assessment, to explore whether IVR can improve cognitive function simultaneously, and to further analyze the relationship between cognitive and motor function recovery. Overall, this study provides preliminary evidence and a practical basis for the application of IVR in upper limb rehabilitation in early stroke patients. It is suggested that objective doses be included and safety monitoring be improved in the future. At the same time, system logs should be used to drive optimization, and personalized treatment plans should be adjusted according to different injury areas or severity levels, so as to more clearly define the true therapeutic effect, the optimal dose and the applicable population. The authors have nothing to report. The authors declare no conflicts of interest. The authors have nothing to report.